A Review of Pharmacist-Led Counselling for the Skin, Hair and Nail Toxicities of Breast Cancer Chemotherapy

Author

S. ANJALA, M.AMMULU, L. ATCHAYA, R. SUBASHINI


Abstract

 Chemotherapy remains central to the treatment of breast cancer, but it frequently causes dermatological adverse events, including nail toxicity, alopecia, hand-foot syndrome and xerosis. These events are often graded as low severity, yet they can impair hand function, body image and quality of life, and in some patients they contribute to dose delays, dose reductions or early treatment discontinuation. Patients are often not warned about them in advance, and clinicians may under-detect them, in part because the standard grading system captures functional impact poorly. Physical and topical preventive measures have variable evidence. Cryotherapy with frozen gloves and socks and scalp cooling are supported by randomised trials, whereas evidence for topical prophylaxis of hand-foot syndrome is mixed. Because prevention depends heavily on what patients do at home, education is a central intervention. Pharmacist-led counselling has been shown in randomised trials from Malaysia and Nepal, and in observational and quality-improvement studies from several other countries, to improve quality of life and reduce anxiety and depression in patients receiving chemotherapy, but few studies have measured dermatological outcomes directly. This review describes the spectrum and impact of chemotherapy-related skin, hair and nail toxicities in breast cancer, summarises the evidence for preventive measures and for pharmacist-led counselling, briefly considers routinely available inflammatory indices as possible future risk-stratification tools, and proposes a cycle-by-cycle counselling framework suitable for resource-constrained oncology units, with particular attention to Indian practice.


Keywords

breast cancer; chemotherapy; dermatological adverse events; nail toxicity; alopecia; hand-foot syndrome; clinical pharmacist; patient counselling; cryotherapy; supportive care



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References


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